Medical devices useful for fixating soft tissue bone are known in the art. These devices include screws, bone pins, staples, sutures and suture anchors. Of particular interest in orthopedic reconstructive surgical procedures, in particular in sports medicine procedures, are suture anchors. Suture anchors typically consist of a member having a suture mounted thereto. Surgical needles are typically mounted to the ends of the suture to provide for the penetration of tissue. A suture anchor is typically inserted into a bore hole drilled into a bone, although the suture anchor may be self-tapping. The suture anchor is secured in the bore hole in a conventional manner by the member, which engages the bone surrounding the bore hole. The suture extends out from the bore hole and is used to attach soft tissue including a tendons, cartilage, ligaments, etc., to the surface of the bone. Most suture anchors typically include some type of a passage, cavity, opening or hole in the member for mounting a suture. The passage may, for example, be a bore extending through the member, a groove or slot in the member, or an eyelet mounted to the member. The passage may be contained in the proximal section of the anchor, the middle, or in a distal section.
Several types of suture anchor devices are known in the art. One type of suture anchor is known as an “arced” anchor. This type of suture anchor is disclosed in U.S. Pat. Nos. 4,898,156, 5,207,679, 5,217,486, 5,417,712, 5,505,735, and 5,522,845, which are incorporated by reference. The arced anchor may have a cylindrical body member. Elastically deformable arc members extend from the body member. Suture is typically mounted in a suture mounting passage in the anchor member or about the anchor member, for example in an eyelet. The arc members are deformed backward during insertion by the hard outer cortex of the bone as the anchor is inserted into a bone bore hole. When in place in the bone bore hole, the arcs subsequently relax in the cancellous bone region, allowing the arcs to engage cancellous bone and thereby fixating the suture anchor in the bore hole.
Another type of suture anchor is a threaded anchor. Many threaded anchors are self-tapping and do not require a pre-drilled bone bore hole, while other threaded anchors require a drilled, or drilled and tapped bore hole. The anchors have an elongated body with a plurality of thread flights, and may include a distal point end. Some threaded anchors include a cutting flute. Threaded anchors typically have a proximal drive end that is engaged by a driving instrument to rotate the threaded anchor into position within the bone. A suture is typically mounted to the anchor, for example, in a hole or passage contained in the anchor body or to an eyelet. Examples of screw threaded suture anchors are contained in U.S. Pat. Nos. 5,013,316, 5,411,506 and 5,411,523, which are incorporated by reference.
Another type of suture anchor that is known in this art is referred to as a “wedge” suture anchor. The wedge anchor typically has a substantially triangular profile, and may have other profiles as well. A suture is typically mounted in a hole or passage contained in the wedge anchor body. The wedge anchor is inserted into a bone bore hole and caused to partially rotate or toggle, thereby causing one or more edges of the anchor to engage bone surrounding the bore hole. Examples of wedge anchors are contained in U.S. Pat. Nos. 5,683,418 and 6,527,795, which are incorporated by reference. Other types of suture anchors are also known in the art including force-fit anchors having compressible and/or expandable anchor bodies, two-piece expansion anchors that are expanded after placement in a bone bore hole, and temperature induced and stress induced shape-memory anchors.
Suture anchors may be designed to accommodate more than one suture mounted to the anchor. These multi-suture anchors are used to achieve satisfactory soft-tissue fixation to a bone surface in certain surgical procedures. For example, multiple sutures mounted to an anchor are often needed in surgical procedures to repair the rotator cuff, in plastic surgery, in cosmetic procedures, and in surgical procedures involving repair of the knee, ankle, elbow, hand, Achilles tendon, etc.
One way to provide multiple suture is to enlarge the passage in the anchor to accommodate multiple sutures. However, there are deficiencies associated with the use of such suture anchors in surgical procedures. The deficiencies include suture binding, tangling, inadvertent knotting and twisting, all of which may interfere with the surgeon's ability to efficiently perform a surgical procedure. Alternatively, an anchor may be designed to accommodate multiple sutures by including multiple passages for sutures. For example, one suture passage through an anchor may be located proximally to another passage through the anchor. Examples of suture anchors having multiple suture passages are contained in U.S. Pat. No. 6,045,573, and copending U.S. patent application Ser. No. 10/458,482, which are incorporated by reference. Anchors having multiple suture passages relieve many of the deficiencies associated with the accommodation of multiple sutures in a single passage.
The correct deployment and positioning of suture anchors and of the sutures mounted thereon, is critical to the success of a surgical procedure. It is therefore important for the surgeon to be able to identify the individual sutures mounted to a multi-suture anchor. Suture identification is typically accomplished by color-coding of the individual sutures mounted to a multi-suture anchor.
When inserting into bone a multi-suture anchor having multiple suture passages, it is often necessary for the surgeon to know which of the multiple sutures is mounted to a particular passage in the anchor. For example, when approximating soft tissue to bone using a multi-suture suture anchor having multiple passages, a surgeon may prefer to first use a suture a suture that passes through a more proximally located suture passage of an anchor, before using a suture that passes through a more distally located suture passage in order to provide optimal soft tissue fixation. Although differentiating sutures by color coding may assist the surgeon, color-coding of sutures alone does not necessarily identify specific locations of suture passages through a multi-suture anchor. In addition, many suture anchor insertion tools hide from the surgeon's view the positions of the suture passages during insertion of the anchor, making it difficult for a surgeon to achieve a desired orientation of the anchor in bone.
Accordingly there is a need in this art for novel suture anchor insertion instruments that can be used with multi-suture anchors that have more than one suture passage, and novel procedures using such instruments, to enable the surgeon to identify individual suture strands with individual suture passages of the anchor.